Erlotinib (Tarceva®)

OncoLink Last Modified: August 21, 2011

Pronounced: er-LOE-ti-nibClassification: Tyrosine Kinase Inhibitor

About Erlotinib

Erlotinib is a small molecule drug that inhibits tyrosine kinase, an enzyme associated with the human Epidermal Growth Factor Receptor (EGFR). By inhibiting this enzyme, erlotinib prevents EGFRs from stimulating the uncontrolled growth of cells that contributes to tumor growth.

How to Take Erlotinib

Erlotinib comes as a tablet to take by mouth. It is usually taken on an empty stomach once a day, at least 1 hour before or 2 hours after eating a meal or snack. Take erlotinib at around the same time every day. Certain medications can interfere with how erlotinib works, so be sure to tell your healthcare team about all medications, vitamins and supplements you are taking. Grapefruit or grapefruit juice can also interfere with erlotinib and should be avoided.

Possible Side Effects of Erlotinib

There are a number of things you can do to manage the side effects of Erlotinib. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:

Nail and Skin Changes

Erlotinib has some unique nail and skin side effects that you may develop. Patients may develop a rash. While this rash may look like acne, it is not, and should not be treated with acne medications. The rash may appear red, swollen, crusty and dry and feel sore. You may also develop very dry skin, which may crack, be itchy or become flaky or scaly. The rash typically starts in the first week of treatment, but can occur at any time during treatment. Tips for managing your skin include:

Use a thick, alcohol-free emollient lotion or cream on your skin at least twice a day, including right after bathing.

Sun exposure can worsen the rash. Use a sunscreen with an SPF of 30 or higher and wear a hat and sunglasses to protect your head and face from the sun.

Bathe in cool or lukewarm water and pat your skin dry.

Use soaps, lotions and laundry detergents without alcohol, perfumes or dyes.

Wear gloves to wash dishes or do housework or gardening.

Drink plenty of water and try not to scratch or rub your skin.

Notify your healthcare team if you develop a rash as they may have management suggestions and/or prescribe a topical medication to apply to the rash or an oral medication.

While receiving erlotinib, you may develop an inflammation of the skin around the nail bed/cuticle areas of toes or fingers, which is called paronychia. It can appear red, swollen or pus filled. Nails may develop "ridges" in them or fall off. You may also develop cuts or cracks that look like small paper cuts in the skin on your toes, fingers or knuckles. These side effects may appear several months after starting treatment, but can last for many months after treatment stops.

Follow the same recommendations for your skin (above).

Don't bite your nails or cuticles or cut the cuticles.

Keep your fingernails and toenails clean and dry.

You may use nail polish, but do not wear fake nails.

Notify your doctor or nurse if any nails fall off or you develop any of these side effects or other skin abnormalities.

Eye Concerns

While receiving erlotinib, your eyelashes may grow very fast, become very long and bother your eyes. Some patients may develop irritation or damage to the cornea (clear part covers the eyeball) or changes in your eyesight. Notify your healthcare team if you develop any eye pain or vision changes.

Nausea and/or Vomiting

Take anti-nausea medications as prescribed. If you continue to have nausea or vomiting, notify your doctor or nurse so they can help you manage this side effect. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms. Read the Nausea & Vomiting Tip Sheet for more suggestions.

Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication or for 6 months following therapy. Effective birth control is necessary during treatment, even if your menstrual cycle stops or you believe your sperm is affected. Erlotinib can also be passed through breast milk, therefore women should not breast feed while using this medication. See OncoLink's section on sexuality for helpful tips for dealing with these side effects.

Fatigue

While on cancer treatment you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team and see OncoLink's section on fatigue for helpful tips on dealing with this side effect.

Diarrhea

Your oncology team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole grain breads, cereals and seeds. Soluble fiber is found in some foods that absorbs fluid and can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange and grapefruit sections, boiled potatoes, white rice and products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses on non-alcoholic, un-caffeinated fluid a day to prevent dehydration. Read Low Fiber Diet for Diarrhea for more tips.

Lung Problems

In a few cases, patients developed a rare lung problem called Interstitial Lung Disease (ILD) while receiving erlotinib. Notify your healthcare team right away if you develop shortness of breath, new or worsening cough or have any difficulty breathing.

Other Side Effects

In rare cases, patients developed a serious, sometimes fatal, problem called gastrointestinal perforation, which is the development of a hole in the stomach or small or large intestine. If you develop abdominal pain, nausea, vomiting, constipation or fever, you should notify your healthcare team immediately.

Smoking

Smoking may affect how well Tarceva works for you. If you smoke, you should stop smoking before starting treatment with Tarceva. Talk with your HCP about how to quit smoking and learn more on OncoLink.